Guide to OSCE

ATTENTION: the OSCE is currently undergoing minor changes. We will update the site in the next few days

Theoretical basis of the examination

The examination at the end of the „Critical Care“ course is organised as a four station modified OSCE (Objective Structured Clinical Examination). While this format has been the norm for testing clinical skills in western European countries, this will be a first contact with this format for most of our students. To make your experience as seamless as possible, we created this guide to help you and inform you about what awaits you on the day of the exam.

We based the concept of the exam on currently accepted teaching theories so we could maintain maximal validity (i.e. the content of the exam covers what is intended to be examined) and reliability (i.e. the test result would always be identical for any variant of the assignment or examiner). Each station tests different levels of learning according to Miller's pyramid of clinical competencies (Fig. 1). The written parts mainly test knowledge ("knows") as the lowest, but basic level of learning, and understanding ("knows how") for some contextually based questions. Orally tested case studies mainly test the understanding of the subject and simulations test how you are able to turn this knowledge and understanding into practical skills ("shows how"). 

It is not necessary to pass all stations to pass the test, the final result is an average of the percentages of the scores at each. To pass, this average should be above a predetermined pass-mark. There are no “killer” questions or stations. 

Because some assignments are bound to be more difficult than others, we decided to standardize it, which in practice means that we have assigned different pass-marks to different assignments. It is therefore not possible to issue a general statement on a passing grade. We set the standard using a modified Angoff method, which is the most commonly used standardization method worldwide. Angoff standardization is so-called criterion-referenced, which means that the success rate does not depend on the results of the examined students. It is a two-round process where everyone who tests your exam has to come to a consensus on the pass-mark. You might find more information of standard setting here: https://www.maxinity.co.uk/blog/standard-setting-simplified-assessments

We want to assure you that we are doing everything in our power to make the results of the exam reflect your knowledge and skills and not the test variant, examiners or luck.

Practical information

The examination takes place in four stations, each station has a strict 6-minutes time limit: 1) a written test on the physiology and pathophysiology relevant to resuscitation and intensive care; 2) a written test on clinical interventions in intensive care; 3) a mini-case 4) a simulation. All candidates will be given the same questions and scenarios. 

Because the organisation of the exam requires a lot of resources, we only organise a few dates per year and we never add dates for the exam. We ask all candidates to arrive 15 minutes in advance for registration. You will be given a candidate number, which also represents the order in which you will be taking the exam. During registration, you will also be asked to leave your mobile phone with us. After a brief introduction, all candidates take the two written tests in room “A” (station 1 + 2). After, the first two students have 6 minutes to get acquainted with the mini-case which they will be discussing in station 3. The other candidates are free to read, eat or drink, but they are not allowed to leave room “A” in order to limit transmission of information between candidates. After preparing, the first two candidates leave room “A”, one candidate goes to station 3 (mini-case), and one candidate goes to station 4 (simulation). They switch after 6 minutes. After finishing all four stations, the examination is over, the candidates submit the materials for the mini-case, get their mobile phones back and leave. 

The results of the examination are usually recorded in SIS within one week, sometimes earlier. At that point, there no individual feedback will be provided. However, we believe that the exam is an opportunity to learn, therefore we offer feedback to all interested candidates at the end of the exam block, when all students have been examined.

Station 1 - Test in physiology and pathophysiology

In six minutes, it focuses on important physiological and pathophysiological principles of the most common conditions in emergency and intensive care, as listed in SIS. The format is either a short answer, MCQ (Multiple Choice Question), Matching Items or Extended Matching Items Scenario. In each case, the answers are predefined and candidates receive points based on whether the answers correlate with a predefined template. This method which the reliability of the test over other methods of correction. Therefore, there is no need to write extensive answers - firstly, the time is relatively limited, secondly, the extra information will not add you any points.

Station 2 – Clinical interventions in urgent and intensive care 

The format the same as for station number 1. It focuses on clinical interventions, pharmacology and differential diagnosis in emergency and intensive care medicine. The scope corresponds to what is listed  SIS. There are several life-saving medications which are used in acute conditions, for which there is no time to the right dose and route of administration. For them and only for them, we want you to remember the indication, method of administration and dose (the list is available on vyuka.lf3.cuni.cz)

Station number 3 - Case report

All candidates have six minutes to prepare for the case. Read the case report carefully, take notes and create a clinical scenario. Consider the following questions: What is the patient's main problem? What is the differential diagnosis? What will be the initial management? What are the possible complications that may occur?

This is followed by a six-minute interview with the examiner, who asks all candidates the same predetermined questions with predetermined correct answers. The examiner fills a checklist, you get a point for each correct answer. Answer the question directly, there is no need to explaining anything if not explicitly asked. The goal is to evaluate how you apply basic knowledge in "practice" and whether you know how to quickly deal with acute situations.

Station number 4 - simulation

The simulation takes place on the same simulator that you got acquainted with during the course (Laerdal SimMan 3G). Before starting, in one sentence, you will be put in a clinical situation, and you can start. Situations tend to be straightforward, with common diagnoses. You are helped by a nurse who will not be allowed to give you advice, but will do whatever you want within the possibilities of a standardly equipped hospital. Examine the patient according to the ABCDE algorithm, solve problems as you see them and don't forget to call for help. In real life, a patient's life may depend on whether the doctor present in the first minutes does a few simple things correctly. We tried to teach you these basic principles during the course and during the exam, we test whether you have learned it. Keep it simple and make it quick.